Alberto Vescovi

Closure of Carotid Artery Puncture Site With a Percutaneous Device

The surgical treatment of traumatic neck injuries in patients with hostile anatomy is associated with higher risk of complications, due to the technical challenge and associated clinical conditions. The use of a percutaneous closure device for removal of a 7.5 Fr sheath, nonintentionally implanted into the carotid artery, is reported. The right common carotid sheath was removed after introducing a 0.035-inch guidewire; the Angioseal 8 Fr device was then introduced over the wire, successfully sealing the puncture site. Duplex scan control showed patency of the carotids, sealing of the puncture, and adequate flow in the jugular vein and carotid arteries. This maneuver allowed the safe placement of a percutaneous arterial device (Angioseal) to close the puncture site.

Internal Iliac Artery Branch Stent Grafting for Aortoiliac Aneurysms Using the Apollo Branched Device

The association of aortic and common iliac artery aneurysms requires a special strategy to achieve distal seal during the endovascular exclusion of abdominal aortic aneurysms. Coil embolization of the internal iliac artery before the placement of a bifurcated endograft limb into the external iliac artery is a usual option. Such procedures are usually well tolerated but may result in buttock claudication, postprocedural sexual dysfunction, and colonic ischemia. We report on an alternative repair to preserve internal iliac artery patency using the Apollo iliac branched device.

Pesquisa de marcadores de trombofilia em eventos trombóticos arteriais e venosos: registro de 6 anos de investigação

BACKGROUND: Authors report an epidemiological analysis of the investigation on thrombophilic factors in patients presenting with arterial and/or venous thrombotic events followed at the Angiology and Vascular Surgery Department at CENTERVASC, from January 2001 to January 2007. OBJECTIVE: To assess the prevalence of congenital or acquired thrombophilic markers in venous and/or arterial thrombotic events. METHODS: From January 2001 to January 2007, 224 patients with venous and/or arterial thrombotic events were screened for the presence of congenital or acquired thrombophilic markers independently of age and family history, location of thrombus and presence or absence of other thrombogenic factors. RESULTS: Thrombophilic factors were present in 112 patients (50% of the cases), in whom predominant positive results for antiphospholipid, anticardiolipin and/or lupus anticoagulant antibodies (39 cases) as well as the presence of factor V Leiden (43 cases) were observed. The venous system was the most significantly affected, and other associated thrombogenic factors were present in 56 (50%) carriers of genetic thrombophilic factors. CONCLUSION: The presence of genetic thrombophilic factors in patients with venous and/or arterial thrombotic events, independently of age or presence of other associated factors, was significant.

Prevalência de marcadores de trombofilia em pacientes portadores da síndrome de May-Thurner e trombose de veia ilíaca comum esquerda

BACKGROUND: The relationship between deep venous thrombosis and thrombophilia has been little studied in patients with left common iliac vein compression, clinically known as May-Thurner syndrome. OBJECTIVE: To evaluate the prevalence of thrombophilia markers in patients with May-Thurner syndrome and left common iliac vein thrombosis. METHODS: From March 1999 to December 2008, 20 patients with May-Thurner syndrome and left common iliac vein thrombosis were retrospectively investigated for the presence of thrombophilia markers. RESULTS: The association between May-Thurner syndrome and thrombophilia markers was found in 8 patients (40%). CONCLUSION: There is a high prevalence of thrombophilia markers in patients with May-Thurner syndrome and left common iliac vein thrombosis. The prevalence, however, is not different from that found in patients with deep venous thrombosis without May-Thurner syndrome.

Tratamento endovascular do aneurisma da aorta abdominal em paciente com insuficiência renal crônica

Abstract Non-dialytic chronic renal failure is a contraindication related tothe endovascular treatment of abdominal aortic aneurysms. The useof alternative contrast agents, such as gadolinium, provides good-quality images and is associated with nephrotoxicity. We report a caseof endovascular treatment of an abdominal aortic aneurysm guidedby color-flow Doppler ultrasonography. An 82-year-old male patient,with abdominal aortic aneurysm (55 mm in diameter) and creatinineclearance of 17 ml/min, underwent implantation of modular bifurcatedaortic stent-graft, using that imaging method associated withradioscopy. Iodinated contrast was not used. The immediate resultand 1- and 6-month controls showed complete aneurysm exclusion.Renal function is still unaltered. We conclude that the stent-graftimplantation guided by color-flow Doppler ultrasonography inpatients with nonterminal chronic renal failure and with favorableanatomy is a feasible and safe method.Keywords: Endovascular treatment, abdominal aortic aneurysm,renal failure, color-flow Doppler ultrasonography, duplex scan.

Implante de filtro de veia cava com uso de dióxido de carbono como meio de contraste: série de casos

OBJECTIVE: To assess the use of digital subtraction with carbon dioxide (CO2 ) for vena cava filter implant. METHODS: From April 2010 to February 2011, seven patients underwent inferior vena cava filter placement with digital subtraction angiography with the use of CO2 as contrast media. All patients had iliac and femoral deep venous thrombosis and contraindications for anticoagulation. RESULTS: Technical success was achieved in all cases. Inferior vena cava e renal veins were identified in all cases. There were no evidences of complications related to the use of CO2 during or after the procedure. CONCLUSION: The placement of inferior vena cava filter with CO2 and digital subtraction angiography is safe and effective with good results in patients with renal insufficiency and allergy to iodine.

Angioplastia carotídea com reversão do fluxo em octogenários: relato de caso

Octogenarian patients submitted to carotid angioplasty present higher incidence of neurological events when compared to younger patients and to patients in this same age submitted to carotid endarterectomy. The higher complication rate could be related to anatomic and anatomopathological factors that increase technical difficulties and atheroembolic risk associated with the endovascular procedure. At the operating room, the patient was in dorsal decubitus position and submitted to general anesthesia. Limited transversal surgical access was carried out on the right neck base, with dissection, identification and restoration of the common carotid artery and internal jugular vein. A 8F sheath was implanted cranially oriented into the common carotid by Seldinger technique after endovenous injection of 10.000 UI of heparin. Another 8F sheath was implanted into the internal jugular vein in caudal orientation. Both sheath were connected by the use of infusion set segment. The common carotid artery was clamped with a silastic double lace, establishing reversion of blood flow in the internal carotid artery. The lesion was crossed by 0.014 x 190 cm wire and the carotid angioplasty was performed employing a 5 x 20 mm ballon and a stent (Wallstent® 7 x 50 - Boston Scientific) was introduced, positioned and released. Carotid angioplasty with transcervical flow reversal is a cost effective brain protection strategy, associated to low embolic potential in octagenarian patients with unfavorable anatomy.

Angioplastia subintimal sem o uso de stent em paciente diabético portador de lesão complexa no pé

Diabetic patients presenting with both peripheral vascular disease and complex soft-tissue defects are often treated by primary amputation. We report the case of a 66-year-old female patient with multiple comorbid conditions. She presented left foot plantar abscess and TASC C superficial femoral lesion. Endovascular revascularization of the left lower limb was performed employing the subintimal angioplasty technique, without stenting or endografting. This combined approach of lower limb revascularization associated with intensive care in diabetic foot wounds should always be considered before amputation. We recommend subintimal angioplasty as an option for high-risk patients with complex limb wounds.

O impacto da tecnologia no tratamento do trauma vascular iatrogênico cervicotorácico: estudo de dois casos com intervalo de três décadas e revisão da literatura

Abstract Complications such as pseudoaneurysms (PA) related to cervicothoracic venous access can be devastating. In this article, we present two similar cases in which technological advances impacted diagnosis, treatment, and results. Both patients developed massive PA after deep venous puncture attempts. The first case occurred in 1993 and was diagnosed by a duplex scan that revealed a large PA originating from the right subclavian artery. The artery was approached by median sternotomy with supraclavicular extension. The PA originated from the thyrocervical trunk and was treated with simple ligation. The second case was in 2017. Angiotomography revealed a PA originating in the vertebral artery, which was treated with endovascular techniques, maintaining vessel patency. Both patients progressed satisfactorily, despite quite different approaches. Cervicothoracic vascular lesions represent a diagnostic and therapeutic challenge, where the risk of rupture is high. Technological advances have reduced the risks involved in management of vascular injuries with difficult surgical access.Complications such as pseudoaneurysms (PA) related to cervicothoracic venous access can be devastating. In this article, we present two similar cases in which technological advances impacted diagnosis, treatment, and results. Both patients developed massive PA after deep venous puncture attempts. The first case occurred in 1993 and was diagnosed by a duplex scan that revealed a large PA originating from the right subclavian artery. The artery was approached by median sternotomy with supraclavicular extension. The PA originated from the thyrocervical trunk and was treated with simple ligation. The second case was in 2017. Angiotomography revealed a PA originating in the vertebral artery, which was treated with endovascular techniques, maintaining vessel patency. Both patients progressed satisfactorily, despite quite different approaches. Cervicothoracic vascular lesions represent a diagnostic and therapeutic challenge, where the risk of rupture is high. Technological advances have reduced the risks involved in management of vascular injuries with difficult surgical access.

Endovascular therapeutic options for the treatment of aortoiliac aneurysms

About 20% of patients with abdominal aortic aneurysms have associated iliac aneurysms. Distal sealing during the endovascular treatment of aortic-iliac aneurysms is a challenge that has led to the emergence of several technical options to achieve this goal over the years. Internal iliac artery embolization is associated with the risk of ischemic complications, such as gluteal necrosis, lower limb neurological deficit, colonic ischemia, impotence and gluteal claudication. This article summarizes the technical options for endovascular treatment of aortoiliac aneurysms with different approaches to preserving the patency of internal iliac arteries.